Organization
RITE AID OF PENNSYLVANIA LLC
Active
Other names
RITE AID PHARMACY 03457
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER ZOREK (MANAGER ONLINE ADJUDICATION)
(717) 975-5937
Entity
Organization
Contact information
Practice address
136 NORTH 63RD STREET, PHILADELPHIA, PA 19139-2201
(215) 472-7820
Mailing address
200 NEWBERRY COMMONS, ETTERS, PA 17319-9363
(717) 761-2633
(717) 975-8659
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PP414845L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007292980324
MEDICAID DME
PA
05
—
1007292980324
—
PA
01
—
3967758
OTHER ID NUMBER
—
Enumeration date
10/13/2006
Last updated
08/13/2020
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